Behavioural strategies for quitting smoking: What works?

The Bottom Line

  • Around one in four adults across the globe smoke tobacco, increasing their risk for illness and premature death. 
  • A variety of behavioural strategies may help healthy adults quit smoking for different durations compared to brief advice, these include text messages, telephone counseling, health education, motivational interviews, self-help materials combined with telephone counseling, financial incentives, video counselling, and face-to-face cognitive education.
  • You don’t have to quit smoking alone! Work with your healthcare team to create a quit plan that matches your goals and needs and incorporates strategies appropriate for you.    

Tobacco use is an epidemic and smoking is the most common culprit (1).

Globally, it’s estimated that approximately one in every four adults smoke tobacco (2). This is alarming given that smoking is one of the main causes of illness and early death (1;2). Older age groups, such as those aged 50 to 69 and 70 plus, are especially impacted, as most smoking-related deaths occur in these populations (2).

So, what should people who smoke do? Quitting… is the obvious answer. But, as we know, the road to quitting is rarely smooth or easy. For many, it takes more than the desire to quit alone. Achieving this goal requires support.

Support can come in the form of medications, behavioural strategies, or a combination of both (3;4). Behavioural strategies, which aim to decrease or stop smoking by building awareness and knowledge of thoughts, feelings, motivations, skills, values, or coping strategies, can be appealing (3;5-8). This is because medications, while effective, can come with undesirable side effects like sleep problems and nausea (3;4).

So, can behavioural strategies help people who smoke become “quitters”? To answer this question, let’s refer to a recent network meta-analysis that assessed the ability of various behavioural strategies to do just that in physically and mentally healthy people (3).

What the research tells us

The review looked at 17 behavioural strategies, of which eight appeared potentially effective but for varying durations, compared to brief advice on quitting smoking. Durations for which smoking abstinence was measured included:

  1. continuous abstinence, meaning not smoking from a target quit date all the way up to assessment,
  2. 30-day abstinence, meaning completely abstaining from smoking for a period of 30 days before assessment, and
  3. 7-day abstinence, meaning completely abstaining from smoking for a period of 7 days before assessment.

Overall, motivational interviews, face-to-face cognitive education, and video counselling appeared to be the optimal strategies for each time-period, respectively. However, several other strategies were also found to be effective. For instance, financial incentives had the second most positive impact for all three time periods. Additionally, in order from most effective (following video counselling and financial incentives) to least effective, the other strategies that helped people completely abstain from smoking for 7 days were self-help materials combined with telephone counselling, motivational interviews, health education, telephone counselling alone, and text messages. Unfortunately, e-mail, exercise training, mindfulness-based treatment, no contact, quit-smoking apps, quit smoking websites alone or combined with telephone counselling or text messages, and self-help materials alone don’t appear to be beneficial in healthy people.

More high-quality evidence is needed to further validate some of these results and increase the quality of the evidence base, as our certainty of effectiveness currently ranges from very low to moderate depending on the strategy (3). That said, quitting is key, and there are a diverse range of behavioural strategies, and medications, that may enable folks to reach their goal. People who want to quit smoking should discuss all available supports with their healthcare team and work together to develop a tailored quit plan that aligns with their wants and needs.

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Author Details


  1. World Health Organization. Tobacco. [Internet] 2023. [cited May 2024]. Available from:
  2. Our World in Data. Smoking. [Internet] 2023. [cited May 2024]. Available from:
  3. Xu M, Guo K, Shang X, et al. Network meta-analysis of behavioral programs for smoking quit in healthy people. Am J Prev Me. 2023; 65(2):327-336. doi: 10.1016/j.amepre.2023.02.032.
  4. Courtney RJ, McRobbie H, Tutka P, et al. Effect of cytisine vs varenicline on smoking cessation: A randomized clinical trial. JAMA. 2021; 326(1):56-64. doi: 10.1001/jama.2021.7621.
  5. Somerville LH, Jones RM, Casey BJ. A time of change: Behavioral and neural correlates of adolescent sensitivity to appetitive and aversive environmental cues. Brain Cogn. 2010; 72(1):124-133.
  6. Richards JM, Plate RC, Ernst M. Neural systems underlying motivated behavior in adolescence: Implications for preventive medicine. Prev Med. 2012; 55(suppl):S7-S16 suppl.
  7. Krishnan-Sarin S, Cavallo DA, Cooney JL, et al. An exploratory randomized controlled trial of a novel high-school-based smoking cessation intervention for adolescent smokers using abstinence-contingent incentives and cognitive behavioral therapy. Drug Alcohol Depend. 2013; 132(1-2):346-351.
  8. Matkin W, Ordonez-Mena JM, Hartmann-Boyce J. Telephone counselling for smoking cessation. Cochrane Database Syst Rev. 2019; 5:CD002850. 

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